Hemolysis Elevated Liver Low Platelets Research Articles

The impact of fetal growth restriction on latency in the setting of expectant management of preeclampsia

Fetal growth restriction is a common complication of preeclampsia. Expectant management for qualifying patients has been found to have acceptable maternal safety while improving neonatal outcomes. Whether fetal growth restriction influences the duration of latency during expectant management of preeclampsia is unknown. The objective of the study was to determine whether fetal growth restriction is associated with a reduced interval to delivery in women with preeclampsia being expectantly managed prior to 34 weeks. We performed a retrospective cohort of singleton, live-born, nonanomalous deliveries at the University of Cincinnati Medical Center between 2008 and 2013. Patients were included in our analysis if they were diagnosed with preeclampsia prior to 34 completed weeks and if the initial management plan was to pursue expectant management beyond administration of steroids for fetal lung maturity. Two study groups were determined based on the presence or absence of fetal growth restriction. Patients were delivered when they developed persistent neurological symptoms, severe hypertension refractory to medical therapy, renal insufficiency, nonreassuring fetal status, pulmonary edema, or hemolysis elevated liver low platelet syndrome or when they reached 37 weeks if they remained stable without any other indication for delivery. Our primary outcome was the interval from diagnosis of preeclampsia to delivery, measured in days. Secondary outcomes included indications for delivery, rates of induction and cesarean delivery, development of severe morbidities of preeclampsia, and select neonatal outcomes. We performed a multivariate logistic regression analysis comparing those with fetal growth restriction with those with normally grown fetuses to determine whether there is an association between fetal growth restriction and a shortened interval to delivery, neonatal intensive care unit admission, prolonged neonatal stay, and neonatal mortality. A total of 851 patients met the criteria for preeclampsia, of which 199 met inclusion criteria, 139 (69%) with normal growth, and 60 (31%) with fetal growth restriction. Interval to delivery was significantly shorter in women with fetal growth restriction, median (interquartile range) of 3 (1.6) days vs normal growth, 5 (2.12) days, P < .001. The association between fetal growth restriction and latency less than 7 days remained significant, even after post hoc analysis controlling for confounding variables (adjusted odds ratio, 1.66 [95% confidence interval, 1.12-2.47]). There were no differences in the development of severe disease (85.9 vs 91.7%, P = .26), need for intravenous antihypertensive medications (47.1 vs 46.7%, P = .96), and the development of severe complications of preeclampsia (51.1 vs 42.9%, P = .30) in normally grown and growth-restricted fetuses, respectively. Fewer women with fetal growth restriction attained their scheduled delivery date, 3 of 60 (5.0%), compared with normally grown fetuses,12 of 139 (15.7%), P = .03. Admission to the neonatal intensive care unit, neonatal length of stay, and neonatal mortality were higher when there was fetal growth restriction; however, after a logistic regression analysis, these associations were no longer significant. Fetal growth restriction is associated with a shortened interval to delivery in women undergoing expectant management of preeclampsia when disease is diagnosed prior to 34 weeks. These data may be helpful in counseling patients regarding the expected duration of pregnancy, guiding decision making regarding administration of steroids and determining the need for maternal transport.

PP055. Preliminary results of the more prepared study (microparticle orientated risk evaluation in the prediction of preeclampsia among risk gravidas): A multicenter prospective prognostic marker study

Preeclampsia (PE) is a potentially dangerous pregnancy pathology contributing to a higher worldwide mortality and morbidity. The negative influence of syncytiotrophoblastic microparticles (STBMs) on the placenta and maternal endothelia is thought to play a key role in generating the inflammatory effects that lead to PE symptoms. Doppler sonography of the uterine arteries assists in identifying a risk population, however, the positive predictive value for this method is low. Aim of this study is to evaluate whether STBMs can serve as an accessory marker to conventional Doppler sonography to better identify pregnant women who will actually develop PE. Pregnant women between 19-21 gestational weeks (GW) with abnormal uterine perfusion were enrolled into this prospective study. Plasma samples were taken at inclusion (baseline) and at two further visits at 8 week intervals to follow STBM concentration alterations during pregnancy. The primary endpoint assessed is PE and/or hemolysis, elevated liver, low platelets (HELLP) syndrome. Other PE-associated pathologies (intrauterine growth retardation [IUGR], intrauterine fetal demise [IUFD], placental abruption, premature delivery) constitute the secondary endpoints. Maternal STBM concentrations were measured using a home made Enzyme Linked Sorbent Assay (ELSA) which specifically measures STBMs. The receiver operating characteristics (ROC) for baseline measures are graphically displayed and area under curve (AUC) is estimated including 95% confidence levels. Of the 73 women included in the study, 16 developed PE (cases) and 56 did not (control). After analyses of mid-gestational probes, the ROC curve was in close proximity to the line of no-discrimination. Our preliminary results indicate that the maternal STBM concentration at mid-gestation does not predict the development of PE or associated pregnancy pathologies. Further analysis is underway to assess whether STBM measurements at later gestational time points can predict PE shortly before onset of disease.

Hemolysis Elevated Liver Low Platelet Acute Renal Dysfunction syndrome: evidence for a new entity in the critically ill obstetric patient

The incidence of HELLP syndrome complicated with acute renal failure (ARF) is unknown because of a paucity of large series dealing with this subject. Recent experimental and clinical investigations indicate that ARF presents a condition that exerts a fundamental impact on the course of disease, the evolution of associated complications and on prognosis independently from the type and severity of the underlying disease.

Expression of glycodelin A in decidual tissue of preeclamptic, HELLP and intrauterine growth-restricted pregnancies

During pregnancy, the placenta produces a variety of proteins that are responsible for the establishment of the foeto-maternal tolerance and circulation. The aim of this study was to investigate the expression of glycodelin A (formerly named PP14) in decidual tissue of placentas with intrauterine growth restriction (IUGR), preeclamptic patients, hemolysis, elevated liver, low-platelet (HELLP) patients and normal decidual tissue. Slides of paraffin-embedded decidual tissue of patients with IUGR, preeclamptic patients, HELLP patients and normal-term placentas were incubated with either polyclonal or monoclonal antibodies against glycodelin A. Staining reaction was performed with the ABC reagent. Intensity of immunohistochemical reaction on the slides was analysed using a semi-quantitative score. In addition, expression of glycodelin mRNA was analysed by in situ hybridisation. Expression of glycodelin A was significantly reduced in decidual cells of placentas with IUGR and HELLP, as investigated with both monoclonal and polyclonal antibodies and in situ hybridisation. However, preeclamptic decidual tissue showed no significantly different expression of intensity of glycodelin mRNA compared with normal placental tissue controls. A reduced expression of glycodelin A by decidual cells seems to be related to IUGR and HELLP. Therefore, glycodelin A might play an important role in the pathogeneses of these diseases.

Prediction of maternal and fetal complications in preeclampsia

Preeclampsia is associated with an increased risk for maternal and fetal morbidity. The aim of this study was to identify factors predicting for maternal or fetal complications. One hundred and eleven patients with preeclampsia were included. Endpoint variables were maternal and fetal complications. Any of the diagnosis eclampsia, hemolysis elevated liver low platelet (HELLP) syndrome, oliguria or placental abruption was considered a maternal complication. Fetal complications were: small for gestational age (SGA) infant, umbilical artery pH<7.10 and admittance of the infant to a neonatal intensive care unit (NICU). Independent variables were maternal age, parity, gestational age, renal function, platelet count, liver enzymes and blood pressure. Logistic regression analysis was used for statistical evaluation. The following independent significant predictors were identified: Maternal complication (n=10) was predicted only by diastolic blood pressure; odds ratio (OR) 1.13 (95% confidence interval 1.01-1.25). SGA (n=21) was associated with maternal prepregnancy weight, OR 0.94 (0.89-0.99) and gestational age at debut of preeclampsia, OR 0.97 (0.94-0.99). NICU admittance (n=31) was only predicted by gestational age at delivery, OR 0.80 (0.67-0.96). No association was found between any of the independent variables and a low umbilical artery pH (n= 10). In the surveillance of patients with established preeclampsia, the value of serial blood and urine sampling, which is common practice in many obstetrical units, might be questioned.